| Type of Incident: | Referee |
| Date of Incident: | 2019-04-14 |
| Time of Incident: | 02:30:00 |
| Location of Incident: | Thomas Jefferson Middle School, Field #1, 1407 Sunset Avenue |
| Home Team: | Madera Premier Soccer Madera Scorpions 0 |
| Visiting Team: | SMC Earthquakes 05G Academy |
| Age Group and Gender: | U14G |
| Team Affiliation of Individual Committing Incident: | Madera Premier Soccer Madera Scorpions 0 |
| Incident Summary: | Incidents can only be filed by Club Presidents and DOCs. |
| Comments: | Incidents can only be field by Club President's and Docs. |
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